Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.
J Bone Joint Surg Am. 2013 Sep 4;95(17):e1221-7. doi: 10.2106/JBJS.L.00426.
There is sparse information in the literature on the outcome of Maisonneuve-type pronation-external rotation ankle fractures treated with syndesmotic screws. The primary aim of this study was to determine the long-term results of such treatment of these fractures as indicated by standardized patient-based and physician-based outcome measures. The secondary aim was to identify predictors of the outcome with use of bivariate and multivariate statistical analysis.
Fifty patients with pronation-external rotation (predominantly Maisonneuve) fractures were treated with open reduction and internal fixation of the syndesmosis utilizing only one or two screws. The results were evaluated at a mean of twenty-one years after the fracture utilizing three standardized outcomes instruments: (1) the Foot and Ankle Ability Measure (FAAM), (2) the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and (3) the Center for Epidemiologic Studies-Depression (CES-D) Scale. Osteoarthritis was graded according to the van Dijk and revised Takakura radiographic scoring systems. Bivariate and multivariate analyses were performed to identify predictors of long-term outcome.
Forty-four (92%) of forty-eighty patients had good or excellent AOFAS scores, and forty-four (90%) of forty-nine had good or excellent FAAM scores. Arthrodesis for severe osteoarthritis was performed in two patients. Radiographic evidence of osteoarthritis was observed in twenty-four (49%) of forty-nine patients. Multivariate analysis identified pain as the most important independent predictor of long-term ankle function as indicated by the AOFAS and FAAM scores, explaining 91% and 53% of the variation in scores, respectively. Analysis of pain as the dependent variable in bivariate analyses revealed that depression, ankle range of motion, and a subsequent surgery were significantly correlated with higher pain scores. No firm conclusions could be drawn after multivariate analysis of predictors of pain.
Long-term functional outcomes at a mean of twenty-one years after pronation-external rotation ankle fractures treated with one or two syndesmotic screws were good to excellent in the great majority of patients despite substantial radiographic evidence of osteoarthritis in one-half of the patients. The most important predictor of long-term functional outcome was patient-reported pain rather than physician-reported function or posttraumatic osteoarthritis. There was no significant association between radiographic signs of posttraumatic osteoarthritis and perceived pain in the present series.
关于采用下胫腓联合螺钉治疗 Maisonneuve 型旋前-外旋型踝关节骨折的文献中仅有少量信息。本研究的主要目的是通过基于患者和基于医生的标准结局测量来确定这种治疗方法的长期结果。次要目的是使用双变量和多变量统计分析来确定结局的预测因素。
采用切开复位内固定术治疗 50 例旋前-外旋（主要为 Maisonneuve 型）骨折患者，仅使用 1 或 2 枚螺钉固定下胫腓联合。骨折后平均 21 年，使用 3 种标准化结局评估工具进行评估：（1）足踝能力测量（FAAM），（2）美国矫形足踝协会（AOFAS）踝关节-后足量表，（3）流行病学研究中心抑郁量表（CES-D）。根据 van Dijk 和改良 Takakura 放射学评分系统对骨关节炎进行分级。进行双变量和多变量分析以确定长期结局的预测因素。
48 例患者中的 44 例（92%）AOFAS 评分良好或优秀，49 例患者中的 44 例（90%）FAAM 评分良好或优秀。2 例患者因严重骨关节炎行踝关节融合术。49 例患者中有 24 例（49%）存在放射学证据的骨关节炎。多变量分析确定疼痛是 AOFAS 和 FAAM 评分所示长期踝关节功能的最重要独立预测因素，分别解释了评分变化的 91%和 53%。双变量分析中疼痛作为因变量的分析显示，抑郁、踝关节活动度和随后的手术与较高的疼痛评分显著相关。多变量分析疼痛的预测因素后，无法得出明确结论。
在采用 1 或 2 枚下胫腓联合螺钉治疗旋前-外旋型踝关节骨折平均 21 年后，大多数患者的长期功能结局良好或优秀，尽管半数患者存在大量放射学证据的骨关节炎。长期功能结局的最重要预测因素是患者报告的疼痛，而不是医生报告的功能或创伤后骨关节炎。在本系列中，没有发现放射学上的创伤后骨关节炎迹象与感知疼痛之间存在显著关联。
